Biceps Tendinopathy / Tendinitis | Anterior Shoulder Pain Rehab (Education & Exercises)

Summary

This video provides a comprehensive guide on managing biceps tendonopathy, a common shoulder issue causing pain in the front of the shoulder, especially during lifting or reaching. It explains how the biceps tendon can become overloaded, and highlights effective strategies for relief, such as modifying exercises, reducing intensity, and slowing movements. Additionally, it emphasizes the importance of gradually reintroducing activities and strengthening surrounding muscles for better shoulder stability. With clear step-by-step instructions, this video helps individuals alleviate pain and recover effectively from biceps tendonopathy, offering practical tips for rehabilitation and long-term recovery.

Takeaways

• 😀 Biceps tendonopathy (formerly biceps tendonitis) is a condition of gradual overload of the long head of the biceps tendon, not primarily an inflammatory issue.
• 😀 The long head of the biceps plays a role in shoulder function, though its exact contribution to shoulder flexion remains debated.
• 😀 Pain in the front of the shoulder is often associated with the long head of the biceps tendon, but it can occur alongside other shoulder pathologies, such as rotator cuff issues.
• 😀 Clinical examinations and special tests for diagnosing biceps tendonopathy are often unreliable, and imaging studies usually show multiple shoulder pathologies simultaneously.
• 😀 The two-step management process for biceps tendonopathy involves modifying aggravating exercises to calm symptoms and gradually progressing back to normal function over time.
• 😀 Modifying exercise variables (e.g., volume, range of motion, speed, intensity) is key in managing symptoms and reducing strain on the tendon.
• 😀 Exercises like the barbell bench press, triceps dips, and overhead presses may need to be modified or substituted to reduce shoulder strain and avoid provocative positions.
• 😀 Gradual reintroduction of modified movements is necessary once symptoms are reduced, starting with light weights and slow tempos before progressing to heavier or faster exercises.
• 😀 Strengthening the surrounding muscles, especially those involved in shoulder external rotation (rotator cuff muscles), can provide additional support and aid recovery.
• 😀 Patience and consistency are vital for long-term recovery, as biceps tendonopathy rehab requires gradual progression, especially for exercises that directly load the tendon, like curls and front raises.

Q & A

What is biceps tendonitis, and why is it often referred to as biceps tendonopathy?

Biceps tendonitis refers to pain in the front of the shoulder, often caused by the long head of the biceps tendon. However, the term 'biceps tendonopathy' is preferred because it highlights the pain and impaired function due to gradual overload of the tendon, rather than inflammation being the primary cause.

What are the two heads of the biceps brachii, and where do they originate?

The biceps brachii consists of two heads: the short head and the long head. The short head originates at the coracoid process of the scapula, while the long head originates at the supraglenoid tubercle of the shoulder blade.

Why is it difficult to isolate the biceps tendon as the sole cause of shoulder pain?

It is difficult because clinical examinations like palpation and special tests are unreliable for diagnosing biceps tendon issues. Additionally, imaging studies like MRIs show that biceps tendon problems rarely occur in isolation and are often accompanied by other conditions, like rotator cuff pathology.

Who is this video intended for?

The video is intended for individuals experiencing non-traumatic pain in the front of the shoulder, worsened by activities that stretch and load the long head of the biceps tendon, such as certain weightlifting exercises and daily movements like reaching behind the back.

What are the two steps in managing biceps tendonopathy?

The two steps are: (1) Modify aggravating exercises and activities to calm symptoms, especially when they are more severe, and (2) Gradually progress back to normal function once symptoms have calmed down, by slowly reintroducing intensity, volume, and speed.

How can volume, range of motion, speed, and intensity be adjusted during tendon rehab?

In tendon rehab, volume refers to the total work done, range of motion involves avoiding provocative positions, speed focuses on slower movements for better control, and intensity refers to the load or difficulty of exercises. Reducing these variables allows the tendon to recover while still maintaining strength and function.

How should exercises like the barbell bench press be modified for someone with biceps tendonopathy?

Exercises like the barbell bench press can be modified by reducing the range of motion, using safety spotter arms, or swapping the exercise for a floor press or push-ups. It's also helpful to reduce the weight as needed and slow down the tempo of the movement.

What role do external rotation and posterior shoulder exercises play in tendon rehab?

External rotation exercises, such as sideline or standing external rotation with a cable or band, and posterior shoulder exercises like A's, T's, and Y's, help strengthen the rotator cuff and surrounding muscles. These exercises provide additional support to the shoulder and can be performed without loading the biceps tendon excessively.

When is it appropriate to perform exercises that load the biceps tendon during rehab?

Exercises that load the biceps tendon should only be performed once symptoms are under control and at a much more tolerable level. These exercises should be introduced gradually, starting with lower-intensity movements, and progress as tolerated.

What is the general guideline for the frequency and intensity of rehab exercises?

For most rehab exercises, the guideline is to perform 2 to 3 sets of 10 to 15 repetitions, 2 to 3 times per week. For exercises that focus on tendon loading, it is important to start slow and controlled, and to progress gradually over several months.